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Therapeutic Diet for Gout Disease

Posted: 29-Aug-2011



Gout is a type of joint disease caused by elevated levels of uric acid that forms crystal deposits in the joints, causing inflammation, pain and swelling. Uric acid is a chemical created as the final breakdown of purine metabolism. Purines are component of nucleoprotein, the building blocks of DNA which determines hereditary characteristics.

Normal Level of Uric Acid in the blood

For men, the level of uric acid should be less than 7.0 milligram per deciliter
For women, the level of uric acid should be less than 6.0 milligram per deciliter

What causes high levels of uric acid?
1.    Under-excretion of uric acid by kidneys due to heredity or side effects from certain types of medication.
2.    High intake of dietary purines:
Purines turn into uric acid in the blood as the final breakdown in the metabolic process. Limiting the intake of high purine foods will reduce the uric acid levels in the blood and urine, especially for people who consume too much of high purine foods. Refer to table to know which are high purine foods.
3.    The breakdown of abnormal cells and organs into purines, eventually resulting in uric acid. A common example is leukemia.  The uric acid created in this process causes increased cell metabolism.  The body excretes this acid via the kidneys through urine and through bile via the large intestine.

The three stages of Gout Symptoms
 
Stage 1 – the patient has high levels of uric acid in the blood but does not have any joint inflammation.
Stage 2 - the patient has high levels of uric acid in the blood and has acute joint pain from time to time and each time lasts only 1 -2 days.
Stage 3 - the patient has high levels of uric acid in the blood and has joint pain more frequently and for a prolonged period of time.

Instruction on the diet

Because uric acid is the result of the breakup of purine, the treatment of Gout is to limit purine intake.

In order to prevent the occurrence of joint pain and inflammation, limit the intake of purine as follows:
1.    Choose foods low in purine instead of high in purine which causes high levels of uric acid in the blood (see table below).
2.    Avoid too much intake of animal flesh especially their internal organs.
3.    Take sufficient carbohydrates to prevent the body from using protein from the muscles
4.    Try not to consume too much fructose for example, honey – as it will breakdown into uric acid in the body.
5.    Choose low fat foods instead of high fat foods. High fat foods such as deep fried foods or vegetable with lots of oil or fatty animal flesh will reduce kidney ability to excrete uric acid which could result in sudden acute joint pain. It is common to find gout patients with high level of fat in their bloodstream. 
6.    Buy or cook food with the following cooking methods: steam, boil, grill, pressure cook or stir fried vegetables with little oil. This is to reduce fat from the food intake, which could help reduce the levels of uric acid retained in our bodies.
7.    Avoid alcohol, especially beer which increases the building up of purines which in turn creates uric acid in the blood and in the urine as well as reduce the excretion of uric acid from our bodies.  
8.    Drink plenty of water between 2-3 liters a day. This will reduce the risk or severity of gout symptoms and the chance of developing renal stone.
9.    Keep your body weight at normal level, for those who are overweight, try to lose the extra weight little by little, not more than ½ kg per week. Because rapid weight loss will increase blood ketone level which will reduce excretion of uric acid by the kidneys.
For more information, please consult your nutritionist.
10.    Beware of certain type of medication which may result in a high level of uric acid, for example, Diuretics.
 

Food Group

Low Purine

(0-50 mg)

Moderate Purine

(50-150 mg)

High Purine

(150 mg)

Flour

Rice, Bread, Sago, Corn

Cracker, Noodles, Macaroni, Pasta, Potato, Sweet Potato

Oat, Biscuit,

Wheat germ,

Wheat grass,

Sweet bread roll

Green bean, Red bean, Black bean, Yellow bean

Vegetables

Salad, Broccoli,

Preserved horse radish, Brussels sprout, Celery

Tomatoes, Cabbage,

Long bean, Carrot, Pumpkin, Cucumber

Bai key lek,

Bamboo shoot,

Stor,

Pak kom,

Mushroom, Cauliflowers

Pea

Kratin, Cha-om

Fruit

Fruit, All kind of fruit juice

 

 

Animal flesh

Peanut butter, Cheese,

 Egg (no more than 4 per week)

Pork, Chicken, Beef, Fish,

Red snapper, Tuna, Salmon, Crab, Ham, Cuttlefish

Fish egg, Animal organs,

 Beardless barb (Pla sai ton),

Spanish mackerel (Pla in-sea),

Anchovy, Herring, Sardine, Mackerel, Scallop, Goose

Milk

Full cream milk,

Skim milk

 

 

Fat

Vegetable oil, Butter

Peanut

 

Drink

Tea, Coffee, Soda drinks

 

 

miscellaneous

Salt,  Vinegar,

 Agar - agar,
Gelatin, Puddings,  Custard, Various spices

 

Soup, Soup cube, Meat soup, Bone soup, Gravy, Fish sauce, Shrimp paste, Yeast


Chalat  Winmoon,M.D.
Orthopaedic Surgery,
Surgery - Spine
Diplomate Thai Board of Orthopedic Surgery
Certificate of A.O. Spine Fellow, Australia
Visiting Spine fellow, Chicago, USA

For further information, contact:
Please Contact Sports & Orthopedic Center
Samitivej Sukhumvit Hospital
1st Floor, Building 1
Tel: 66 (0) 2711-8494-6
Call Center: 66 (0) 2711-8181
E-mail: info@samitivej.co.th
 

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